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NEONATAL RESUSCITATION (Apgar Score)

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  1. How Ready Is This Child? <--- (Apgar Score)

  2. Assess Apgar at 1, 5 minutes, if < 7 at 5 min then again 5 min

Sign

0

1

2

Heart Rate

absent

< 100/minute

> 100/minute

Respiratory Effort

absent

slow, irregular

good, crying

Irritability

no response

grimace

cough or sneeze

Tone/Muscle

limp

some flexion of extremities

active motion

Color

blue, pale

body pink, extremities blue

completely pink

 

 

Initial Resuscitation

  1. always remember ABC's
  2. anticipation - know maternal history, history of pregnancy, labor, and delivery
  3. all infants
    • prevent heat loss by drying, warming (on radiant heater, remove wet towels)
    • position head and neck to open airway for suction
    • stimulate infant
  4. Airway
    • gentle suction of mouth then nose: < 100 mmHg, < 5 seconds
    • with thick meconium, suction the nasopharynx as the headis delivered, then intubate and suction trachea prior to first breath if possible
  5. Breathing
    • check for spontaneous respirations
    • bag and mask if apneic/gasping/HR < 100, bag at a rate of 40-60/minute with 90-100% O2
    • intubation is indicated if
      • prolonged ventilation is required
      • bag and mask are not effective
      • tracheal suctioning is needed (thick meconium)
      • HR remains < 100
      • diaphragmatic hernia is suspected
  6. Circulation
    • heart rate is the most important indicator of the need for intervention
    • "80 or less compress" - if bradycardic (apex < 80 and no improvement with bagging) or asystolic, compressions begin at rate of 120/minute
    • coordinate 3 compressions with 1 ventilation (120 compressions/minute, 40 ventilations/minute) - check after 30 seconds
      • if HR > 80 stop compressions but continue ventilation
  7. Drugs
    • epinephrine - for asystole or severe bradycardia
    • HCO3 (4.2% solution given slowly)
    • CaCO3 - electrical abnormalities
    • Narcan (Naloxone) - if mother given opioids, general anesthetic
NEONATAL RESUSCITATION (Apgar Score) NEONATAL RESUSCITATION (Apgar Score) Reviewed by Radiology Madeeasy on October 09, 2010 Rating: 5
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